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1986, 09-29 Permit App: 00013333 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state of local laws regulating construction or the performance of construction. SIGNATURE OF ��jj OWNER OR /4" --At Ai Li/ APPLICATION DATE %/ i %9 ron Project" / 3533 Owner's Name . Last First MI Project Address (Street Name & Number fel IC"a. s�. \VO1 RL) City `1�I C-eeencuLLa4 State Subtlivision/Plat Name Assessors Parcel pc) -1 .C7� - �7� /- LotLi, Block/ Plat p A s Applicant Address City State Zip Phone Business Phone Contractor Address City Stale Zip Phone Contact Licensell Business Phone Describe Work Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous Dryer Range Gas Log Gas Water Htr. Solid Fuel/ Wood Stove Air Handling Units 0.10,000 CFM 10,000+ CFM Refrigeration Systems/ Heat Pumps (BTU) 1-100M 101-500M 501-1,000M 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 15-30HP 30-50HP 504 -HP Gas Piping 1-5 Outlets 6+ Outlets Gas Fired Heating System 1-100,000BTLL 10.4.00+ BTU I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state of local laws regulating construction or the performance of construction. SIGNATURE OF ��jj OWNER OR /4" --At Ai Li/ APPLICATION DATE %/ i %9 ron